Teething gels are prominently displayed in pharmacy teething sections and are frequently recommended by well-meaning family members. Many parents assume that if a product is sold specifically for babies, it is safe. In the case of teething gels, the picture is more complicated: several categories of gel have been subject to safety warnings, and the evidence for their effectiveness is limited.
Healthbooq covers infant health and evidence-based approaches to common parenting concerns.
What Teething Gels Contain
Teething gels fall into several categories based on their active ingredient:
Local anaesthetic gels (lidocaine or benzocaine). These work by numbing the gum tissue. Products containing lidocaine have historically included Bonjela Teething Gel and similar preparations. Benzocaine-containing products are more common in the United States.
Choline salicylate gels. Bonjela original adult formula contains choline salicylate, a salicylate related to aspirin. This should not be used in children under 16 due to risk of Reye's syndrome.
Herbal and 'natural' gels. Many products are marketed as natural or herbal, containing ingredients such as chamomile extract, clove oil, or other botanicals.
Homeopathic preparations. Products such as some granule preparations are labelled as homeopathic.
The Safety Evidence on Local Anaesthetics
The Medicines and Healthcare products Regulatory Agency (MHRA) in the UK issued guidance in 2014 advising that lidocaine-containing teething gels should not be used in children under 3 years. The concern centres on the systemic absorption of lidocaine through the oral mucosa, particularly when applied repeatedly or in quantities greater than intended.
Lidocaine toxicity in young children has been associated with seizures and cardiac arrhythmias. The case reports that prompted regulatory action typically involved dosing errors or repeated applications, but the MHRA's position was that the margin of safety is insufficient to recommend the products in this age group. The Dental Practitioners' Formulary and prescribing guidance for the UK reflect this restriction.
In the United States, the FDA has warned against the use of benzocaine-containing gels (such as Orajel) in children under 2, citing the risk of methaemoglobinaemia – a condition in which haemoglobin loses its capacity to carry oxygen. Infants are more susceptible to this effect than older children because they have higher levels of foetal haemoglobin and lower levels of the enzyme that reverses the condition.
The Evidence for Herbal Gels
Most herbal teething gels have not been evaluated in randomised controlled trials for efficacy in infant teething. The quantities of active botanical ingredients in commercial preparations are generally too small to have any pharmacological effect, making any perceived benefit likely to reflect the rubbing action (counter-pressure) rather than the gel's chemistry.
What Actually Works for Significant Teething Pain
For teething discomfort that is clearly distressing a child, paracetamol or ibuprofen remain the first-line options. Both are well-evidenced for pain relief, have established paediatric dosing regimens, and have known safety profiles when used at recommended doses. Ibuprofen has the additional benefit of anti-inflammatory action, which may be particularly relevant for the gum inflammation that drives teething discomfort.
Non-pharmacological measures with reasonable evidence include chilled teething rings and gentle gum massage with a clean finger.
Practical Guidance
Given the regulatory warnings around local anaesthetic gels in children under 2-3 years, parents are best advised to avoid lidocaine-containing and benzocaine-containing teething gels in this age group. Choline salicylate gels (Bonjela original) should not be used in children under 16. Products marketed as natural or herbal have no clear evidence of efficacy.
If teething discomfort is significant enough to require intervention, paracetamol or ibuprofen is more effective, better evidenced, and has a clearer safety profile when used at appropriate doses and frequencies.
Key Takeaways
Teething gels are among the most purchased teething products but have a complicated evidence and safety profile. Gels containing lidocaine (such as Bonjela Teething Gel) are not recommended by the MHRA for children under 2 due to risk of seizures and cardiac events from systemic absorption. Benzocaine-containing gels carry a risk of methaemoglobinaemia in infants. Herbal and 'natural' gels (such as those containing chamomile) have no clinical evidence of efficacy beyond placebo. Plain sugar-free sucrose gels have some evidence for short-term neonatal pain relief but are not specifically teething treatments. The most effective pain relief for significant teething discomfort remains age-appropriate paracetamol or ibuprofen.
